Experience with the Belt-fuqua Hypospadias Repair
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No AccessJournal of Urology1 May 1981Experience with the Belt-fuqua Hypospadias Repair Terry W. Hensle, and Daniel L. Mollitt Terry W. HensleTerry W. Hensle More articles by this author , and Daniel L. MollittDaniel L. Mollitt More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)55170-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail From 1977 through 1979, 30 patients underwent complete repair of hypospadias using a modification of the Belt-Fuqua technique. Only those patients with distal and mid shaft hypospadias and chordee were included in this series. Three patients had undergone previous attempts at repair by other methods. The mean age at the time of repair was 6.4 years, with a range of 1 to 18 years. The over-all complication rate was 10 per cent (3 of 30), with 2 fistulas (6.6 per cent) and 1 distal stricture (3 per cent). All patients had an excellent functional result. The absence of midline scars and the glandular meatus resulted in a superior cosmetic appearance. The reliability of this technique, as well as the functional and cosmetic results, warrant consideration in the selection of a procedure for hypospadias repair. © 1981 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByGreenfield S, Sadler B and Wan J (2018) Two-Stage Repair for Severe HypospadiasJournal of Urology, VOL. 152, NO. 2 Part 1, (498-501), Online publication date: 1-Aug-1994.Maizels M and Firlit C (2018) Successful Hypospadias Repair in Infants Using Brief Urinary Diversion and Watertight Neourethral ClosureJournal of Urology, VOL. 135, NO. 4, (752-754), Online publication date: 1-Apr-1986.Shapiro S (2018) Complications of Hypospadias RepairJournal of Urology, VOL. 131, NO. 3, (518-522), Online publication date: 1-Mar-1984.Duckett J (2018) Editorial CommentsJournal of Urology, VOL. 131, NO. 3, (522-522), Online publication date: 1-Mar-1984. (2018) Reply by AuthorJournal of Urology, VOL. 131, NO. 3, (522-522), Online publication date: 1-Mar-1984. Volume 125Issue 5May 1981Page: 703-705 Advertisement Copyright & Permissions© 1981 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Terry W. Hensle More articles by this author Daniel L. Mollitt More articles by this author Expand All Advertisement Loading ...Keywords:
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Meatus
Proximal hypospadias with chordee usually requires two stage procedures: 1st stage is orthoplasty and ventral parking of prepucial skin and 2nd stage is urethroplasty after 6 months of 1st stage. The aim of this study is to describe and report the outcome of a single stage repair- Koyanagi Nanamura procedure for proximal hypospadias with chordee. Between January 2006 to December 2010, 44 boys with proximal hypospadias underwent repair using the Koyanagi Nanamura technique in Paediatric Surgery Department of Faridpur Medical College Hospital and Dhaka Medical College Hospital. The boys' age ranged from 1 to 7 years. The technique employs the use of lateral penile skin and extends into the inner preputial skin. This flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. Follow-up period was 6 months. Satisfactory results were obtained in 39 (88.6%) patients. Three patients developed fistulae. Two patients developed meatal stenosis. Results were considered satisfactory when the boy achieves a glanular meatus, single forward stream, unimpeded voiding, good cosmesis, and no need for secondary surgery for the urethra. Koyanagi Nanamura procedure is a reliable procedure in which the lateral flaps have dual blood supply, which produces good results (88.6%) and is suitable for proximal forms of hypospadias with chordee. Key words: Hypospadias; Chordee; Fistula; Penis DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9202 FMCJ 2011; 6(2): 66-69
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Introduction: The modified Asopa's procedure for repair of hypospadias is well established and suited for patient characteristics for which Snodgrass urethroplasty cannot be done. We describe our experience with this procedure in 30 patients managed with this procedure highlighting the factors affecting outcome in this repair. Materials and Methods: Data of 30 patients (age range 2.5-15 years) who underwent hypospadias repair in a tertiary care teaching institution from 2012 to 2015 with modified Asopa procedure (Hodgson XX technique) utilizing Transverse Preputial Island Flap by a single surgeon were reviewed and retrospectively analyzed according to age of patients, site of meatus, presence or absence or chordee, glans configuration and complications - fistula, glans dehiscence, meatal stenosis. These complications were further analyzed with respect to the various patient characteristics and GMS (Glans, Meatus and Shaft) score. Results: The mean age of presentation was 5.5 years and mean follow-up period was 22 months. The mean total GMS score was 8.5; range being 11 to 5. In total, only six patients had complications (20%). The patients with low GMS score (7 or less) had no complications. The complication rate was more in proximal hypospadias repair (n= 5/24) when compared with distal hypospadias (n=1/6). There were more complications in patients with chordee (n=4/6) and those with conical glans (n=4/6). Conclusion: Location of the meatus, presence/absence of chordee and glans configuration affect outcome in patients undergoing modified Asopa's procedure for hypospadias repair. Keywords: hypospadias; Asopa's procedure; Child; Complications; Outcome .
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Background: Urethroplasty for hypospadias is a difficult surgery in the best of hands. One stage surgery is usually preferred for its multiple benefits. Many techniques exist each with its own merits and demerits. Aim of the study was to compare different techniques in hypospadias surgery with special emphasis on transverse prepucial onlay island flap urethroplasty.Methods: All children operated for hypospadias from the period of 2016-2019 in Department of Surgery at Geetanjali Medical College and Hospital, Udaipur were included in the group after obtained approval from institutional ethical clearance commitee. The technique to be used was decided on a case to case basis depending mainly on the position of the meatus, size of the urethral plate and chordee (ventral curvature). All patients were analyzed for various complications and overall success rate.Results: 77 patients were operated and analyzed. Overall the study could not establish the superiority of one technique above another. At the same time it establishes the versatility, satisfactory results and low complication rate of transverse prepucial onlay island flap (TPOIF) in different types of hypospadias.Conclusions: Success in urethroplasty depends on proper case selection, meticulous technique, a buttressing layer wherever possible and that TPOIF is a versatile technique for single stage hypospadias repair in distal, mid and proximal penile hypospadias.
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Objective To evaluate the application of Snodgrass urethroplasty for the anterior hypospadias.Methods A retrospective review of hypospadias treated by Snodgrass urethroplasty from 2001 to 2005 was performed.Among 146 cases,62 were primary and 84 with redo procedures. In the meantime,onlay island flap procedure was undertaken for the hypospadias without chordee(266 cases).The short and long-term results were compared between these two groups.Results In 62 pri- mary cases by Snodgrass urethroplasty,57 were recovered without any complications,2 cases with u- rethral stricture and 3 cases with urethral fistula;while among 84 redo cases,64 were completely cor- rected,6 cases with urethral stricture and 14 with urethrocutaneous fistula.In 266 cases corrected by onlay island flap,256 were recovered without any complaints and 10 with urethrocutaneous fistula. Conclusions Snodgrass can be recommended for hypospadias cases with wide urethral plate but with- out chordee or parts of failed cases.Onlay island flap is suitable for the narrow urethral plate cases.
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It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20−60 months) and 35 months (18−60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.
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(Background) Pediatric urologists tend to use one-stage procedures for the repair of hypospadias. As there are various types of hypospadias, we cannot repair this disease with a single modality. It is difficult to estimate the exact length of the neourethra in cases of severe hypospadias before surgery.(Methods) After a circumferential incision is made about the coronal sulcus and the chordee is completely released, the distance between the glans tip and the retreated native meatus is measured to determine the length of the neourethra. Urethroplasty with the method of Transverse Preputial Isaand Flap (TPIF) is selected when the distance ranges from 3 to 4cm, while urethroplasty using with modified OUPF IV (Koyanagi) is selected in cases of more than 4cm.(Results) We performed surgery on 14 hypospadiac patients with chordee between April 1996 and April 1997. Eight patients underwent urethroplasty using the TPIF method and 6 underwent urethroplasty with the method of the modified OUPF IV. With the TPIF methods, 7 to 8 patients underwent repair successfully and one experienced urethrocutaneous fistula, while 5 of 6 treated by the modified OUPF IV method has successful repairs and meatal stenosis occured in one patient.(Conclusion) Even if we encounter severe hypospadias, we can treat these patients with one stage repair alternatively. A relatively high success rate was obtained with both methods to repair severe hypospadias.
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To evaluate the factors that may influence the results of surgery after hypospadias repair at National Institute of Child Health, Karachi.It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analysed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. For most patients who had penile or distal hypospadias TIP (Tubularised Incised Plate) urethroplasty was performed. Patients with severe chordee had Duckett Island flap urethroplasty as a two stage procedure. Patients having moderate chordee were subjected to the Mustardee Procedure. Some underwent MAGPI and Mathieu's repairs.One hundred four patients were operated. Files of only 46 patients with a mean age of 4 years could be retrieved and these were included in the study. Twenty five patients had TIP urethroplasty, 5 had island flap urethroplasty, 2 had Mustardee repair, 6 had MAGPI, 5 had Mathew's repair and 3 had Byers Staged Urethroplasty. Over all incidence of fistula formation was 26%. The frequency of fistula formation was less with TIP urethroplasty (16%) compared to those who received no dartos pedicle flap. Mathieu's repair gave good results with 20% incidence of fistula formation. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee.TIP urethroplasty is a safe and reliable method of hypospadias repair. The results of surgery can however be improved by using dartos pedicle flap to protect the repair, meticulous surgical techniques, use of monofilamentous absorbable suture material and soft waterproof dressing.
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Aims: Hypospadias is one of the commonest congenital abnormalities of the male genitalia. Proximal penile hypospadias is the challenging condition to correct. Lateral based flap (LB) procedure combines meatal based flap and pedicle flap technique into one procedure without the need for an intervening anastomosis. In this study we compared Lateral based flap (LB) procedure with conventional two stage urethroplasty for proximal penile hypospadias with chordee. The aim of this study was to find out the outcome of lateral based flap urethroplasty in treating proximal penile hypospadias with chordee over two stage procedure.Study Design: In this prospective study that carried out from 1st January 2012 to 30th June 2013, patients with proximal penile hypospadias from 6 months to 144 months (12yrs) of age attending at Dhaka Shishu (Children) Hospital out patient department were primarily enrolled for this study. Patients were grouped into A and B on the basis of repair by Lateral based flap single stage urethroplasty and by two stage techniques respectively. Results were evaluated after 6 months of urethroplasty and onward.Results: Total 24 Patients, ages ranged from 7 months to 10 years (mean 3.97 years) of proximal penile hypospadias (12patients in each group) were included. For Lateral based flap (LB) procedure (Group-A), mean time required for urethroplasty was 3.23 hours. On the other hand, for control group (Group-B) mean total time required was 3.99 hours (for orthoplasty 1.67 hours and for urethroplasty 2.32 hours). Urethrocutaneous fistula developed in 16.6% (2 patients) and glanular dehiscence in 8.3% (1 patient) in each group. In addition 25% (3 patients) in control group developed meatal stenosis. Satisfactory results were observed more than 83% of group-A patients and 58.3% of group B patients.Conclusions: The study reflects that lateral based flap (LB) procedure technique may offer the patients with proximal and severe forms of hypospadias, a good chance of a single stage operation with high success rate.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21018
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Introduction: We report our results of preputial flap onlay urethroplasty for the one-stage repair of mid- and proximal penile hypospadias with chordee.Materials and Methods: We retrospectively reviewed the hospital data base for children undergoing onlay flap urethroplasty and hypospadias repair for mid- or proximal penile hypospadias with chordee.Results: During the study period January 2000–December 2017, 21 children underwent onlay preputial flap urethroplasty. The procedure was successful in 15 (71.42%) children with no need to undergo further procedures or operations. There were five urethrocutaneous fistulas and dehiscence of glans in one.Conclusions: An onlay urethroplasty using the preputial flap yields results comparable to those of staged techniques and results in fewer procedures under anesthesia in children.
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